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From hypervigilance to integration — trauma-focused therapy and phased treatment
Post-traumatic stress disorder develops in 5–10% of trauma-exposed individuals, characterized by intrusive re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Dr. Ruja's approach follows the International Society for Traumatic Stress Studies (ISTSS) phased model: safety and stabilization first, then trauma processing (PE, CPT, or EMDR), then reconnection and meaning-making. Complex PTSD and dissociative presentations require extended stabilization before trauma-focused work.
Kathmandu Neurology Clinic & Cognitive Center
Authored and reviewed by Dr. Ruja Shrestha (MBBS, MD (Psychiatry), NMC 19766). Evidence-based, no fabricated outcomes.
Post-traumatic stress disorder develops in 5–10% of trauma-exposed individuals, characterized by intrusive re-experiencing, avoidance, negative alterations in cognition and mood, and hyperarousal. Dr. Ruja's approach follows the International Society for Traumatic Stress Studies (ISTSS) phased model: safety and stabilization first, then trauma processing (PE, CPT, or EMDR), then reconnection and meaning-making. Complex PTSD and dissociative presentations require extended stabilization before trauma-focused work.
Reviewed by Dr. Ruja Shrestha, MBBS, MD — Consultant Psychiatrist & CBT Therapist (NMC 19766), Kathmandu Neurology Clinic. For evaluation, book an appointment.
PTSD diagnosis requires exposure to actual or threatened death, serious injury, or sexual violence, plus the four symptom clusters. The clinic uses the PCL-5 (PTSD Checklist), CAPS-5 when available, and thorough trauma history including childhood adversity (ACE score). Formulation considers not just the index trauma but cumulative load, developmental timing, dissociative features, and moral injury. Medical mimics (hyperthyroid, substance withdrawal, seizure disorders) are excluded.
Phase 1: Safety, stabilization, and skill-building (psychoeducation, grounding techniques, distress tolerance, sleep hygiene, reducing substance use). Phase 2: Trauma processing (prolonged exposure, cognitive processing therapy, or EMDR) — typically 8–15 sessions once stabilized. Phase 3: Reconnection, meaning-making, and relapse prevention. The clinic monitors progress with PCL-5 at each phase transition. Complex PTSD or severe dissociation may require 3–6 months of stabilization before processing.
Guidelines referenced:
ISTSS Guidelines for the Treatment of PTSD and Acute Stress DisorderFoa EB, McLean CP, Zang Y et al. Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered therapy on PTSD symptom severity: a randomized clinical trial. JAMA PsychiatryShapiro F. Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition. Guilford PressContent on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.